Aim and objective: We report our experience with anesthesia management of craniosynostosis surgeries at a tertiary care children's hospital.
Materials and methods: We conducted a retrospective analysis of craniosynostosis surgeries performed at our institute over the last 3 years.
Review results: Twelve children underwent reconstructive surgery over a period of 3 years. Eight patients underwent IV induction with propofol followed by atracurium. In four patients where difficult airway was anticipated, an inhalational induction with sevoflurane was performed. Anesthesia was maintained using air, oxygen, and sevoflurane delivered through a closed circuit, and dexmedetomidine @ 0.5 μg/kg/hour. Fentanyl and paracetamol were used for analgesia. Monitoring included standard ASA monitors and additionally, arterial blood pressure and urine output monitoring. Tranexamic acid was used to reduce bleeding. There was no incidence of major intraoperative complications viz. venous air embolism, massive hemorrhage, or hemodynamic instability. No patient needed vasoactive infusion support.
Conclusion: Surgery for craniosynostosis poses several challenges for anesthesia. Having a protocolized approach to anesthesia management and transfusion can result in good outcomes.
Clinical significance: Raised intracranial pressure, obstructive sleep apnea, syndromic associations are common in craniosynostosis. Surgery in infancy poses additional challenges of massive blood loss. The anesthetist has to be vigilant and step up monitoring to detect and manage perioperative complications.
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